Monday, November 19, 2012

FPWR Conference - Janice Agarwal, PT, CNDT - Sensory Integration


This lecture is from the FPWR Conference last weekend. It was one that I thought would be *somewhat* applicable to Dean since he seems to have *some* sensory issues, but what I didn't realize was how much it would apply to him AND to my other kids....  Check it out! As usual, let me know if you have questions about it. :) 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Janice Agarwal
Sensory Integration and Children with PWS: What All Parents and Providers Need to Know

-Sensory Integration: the ability to organize, synthesize, and process incoming sensory information received from the body and the environment to produce purposeful, goal-directed process
-lack of moving in utero and out means that we have to teach them appropriate sensory experiences

We may see:
-an acute awareness of background noises
-fascination with lights, fans, and water
-spinning items, taking things apart
-coordination problems
-unusually high (or low) activity level (because have to use more energy to do the same things as everyone else)
-difficulty with transitions
-an unusual sensitivity to sounds and smells


Sensory Integration
-this processing and organizational ability is
            -foundation for motor skills
            -social behaviors and
            -the ability to accomplish more complicated learning tasks both in school and at home
-our kids with PWS can’t compensate with activities like doodling, hair twirling, etc. to listen
-all children who are born with abnormal tone have Sensory Integration Deficiencies
-we have to teach therapists that sensory issues are there before you can even see them exhibited

An undeveloped system feels “attacked”

Vestibular
Provides information about movement, gravity, and the changing of head position

Helps us to stabilize our eyes when we are moving and tells us if objects around us are moving or remaining still

Balance

Receptors are semicircular canals (oriented at right angles to each other so that they represent 3 planes in space)

Very malleable system and if you don’t use it, you lose it

What we see with a problem:
-hypotonia
-clumsiness
-unpredictable behavior
-tantrums
-overly impulsive
-poor attention – vestibular input helps get the brain ready to act, think, and participate
-no handedness

What we can do:
-swinging – linear – calming, relaxing, easiest to handle à if child cries, you stop, give them comfort, and then jump back in when you get a chance
-rocking – linear
-spinning on a swivel chair, sit & spin, scooter board, tire swing, in a heavy towel
-bouncing on large balls, air mattress (put against wall and slam into it)
-games such as hopscotch, catching balls, soccer, baseball, tag
-riding on a trike, bikes or scooters
-slides – waterparks or regular slides
-roughhousing or wrestling
-somersaulting

Calming vestibular is slow, rhythmic, linear swinging or rocking, gentle slow spinning in one direction

Proprioception
Input provider

Unconscious awareness of body position

Tells us about the position of our body parts, their relation to each other, their relation to other people and objects

It communicates how much force is needed for muscle contraction and allows us to grade our movements

Feeds back information about position, movement, and balance from other system,s including the peripheral and CNS

Receptors are located in the joints

Deficiencies:
-bites or chews objects, hands, nails
-grinds teeth
-mushy speech
-walks next to walls or gently touches them
-poor writing
-difficulty coloring between lines
-works hard at writing pressing hard to give input

Treatment:
-deep brushing
-weighted vests
-massages
-clothes
-blankets
-tight clothes with compression – calming
-gross motor activities – trampolines
-digging in the garden (hiding things and dig for treasure), sandbox
-carrying heavy objects
-walking with a backpack
-hammering nails
-jumping on trampoline, air mattresses
-pounding and rolling play-doh, clay, squeezy toys
-pillow fights
-karate
-Wii-fit
-Zumba
-pushing or pulling heavy laundry baskets, light furniture or wheelbarrows/wagons
-swimming or extra bathtime
-silly animal walks
-tumbling on the ground
-weight lifting (supervised)
-Pilates

Tactile
Information about light touch, pressure, vibration, temperature, and pain

Feedback from this system contirubtes to the development of body awareness and motor planning abilities

Most sensitive system

Gives concrete feelings of body and environment

Exposed to the most abuse

Deficiencies:
-desensitized to cuts, bruises, pain, temperature
-does not like having hair brushed or teeth brushed
-flicks of shakes hands, rubs face, licks or chews lips
-sloppy handwriting, eating, and dressing
-picks at skin

Warning: light touch is very alerting à using light touch alerts the protective system and can make the child feel threatened
-for some, new clothes may be intolerable
-an insect bite can make some children crazy and they scratch until bleeding or deep
-some don’t like fingerpainting

Treatment:
-brushing, rolling, deep massage
-vibration
-deep pressure and joint compression
-dress up box with gloves, shoes, hats
-hand massages
-painting
-pet care – brushing, grooming, petting
-rubber gloves (doubled filled with rice of flour)
-sensory toys to fidget with: koosh balls, slinkys
-plastic pop beads
-sitting in a bean bag chair/seat
-sew in washers or pennies in bedding to create weighted blanket

Deep pressure during stressful situation can increase serotonin and calm

Oral Motor
Input plays a large part in maintaining a child’s level or arousal

Oral function is connected to your posture and respiration

A child’s suck-swallow-breath synchrony is important

Sucking promotes trunk flexion

Blowing promotes trunk extension

Biting promotes jaw, neck, shoulder, and pelvic stability

Crunching and chewing promotes balance/stability and mobility, and the jaw, neck, shoulder, and pelvis

Eating is the most sensory-intensive activity that we have and we need to use it to regulate our children

Oral motor can help a child calm or alert themselves so they can play and interact with peers

Treatment:
-blowing bubbles or whistles
-cold or frozen grapes, popsicles, bananas
-chewy bagels, dried fruit, fruit rollup, gum, beef jerky
-crunchy pretzels, veggies, popcorn, apples, rice cakes, cereal (use yogurt instead of milk)
-sour/tart – cranberries, tart lemon/lime wedges, warheads, or sour candies, sour sprays (Janice uses sour spray as a reward)
-sucking – hard candies, citrus fruit wedges, lollipops, jawbreakers, use a straw to suck up applesauce or jello
-tugging, biting, pulling – licorice, fruit leather, beef jerky
-warm – soup, oatmeal, tea


Sensory Diet
-morning à vibrating toothbrush, massage feet and back to help wake up; jump on trampoline,

School à should include movement breaks or provide crunch/chewing, oral comfort while doing handwriting or listening to stories

Lunch Time – provide meal that meets the needs of your child – do they need to be calmed or excited?

After school: go outside and play, push grocery cart, do chores with weighted laundry baskets,

Spinning

Massage feet to reorganize, use therapy putty, make body sandwiches

Dinnertime: help set table, provide crunchy/chewy foods, add spices

Bedtime: warm bath with bubbles and calming essential oil, massage during reading time

Travel with kids, prepare for the unexpected
-plan, plan, plan
-starting talking about it weeks or months before and involve them in the process
-have snacks and “mini meals” on board just in case
-have a system that rewards good behavior
-daily massages before heading out and while on the trip
-massage feet and hands to calm
-have them massage you
-bring games they know, movies, iPods
-they need daily jobs
-when the unexpected happens, sit back and give them a massage

No comments: